Canadian Journal of Anesthesia, Vol 42, 621-624, Copyright © 1995 by Canadian Anesthesiologists' Society

ARTICLES

Epidural blood patch in a seven-year-old child

L Roy, D Vischoff and J Lavoie
Department of Anaesthesia, Hopital Sainte-Justine, Montreal, Canada.

We present an unusual case of postoperative headache in a child after an epidural block. A seven-year-old girl (ASA 1) was scheduled to undergo a urological procedure under general anaesthesia combined with an epidural technique for intra- and postoperative analgesia. Although there was no evidence of dural puncture when the block was performed, the patient developed a headache postoperatively. The headache, which was accompanied by neck pain, appeared in the sitting or standing position and was relieved by decubitus. According to the mother, her child had never complained of those symptoms in the past. After independent evaluation by an anaesthetist and a neurologist, a postdural puncture headache (PDPH) was considered the most likely diagnosis. As oral analgesics failed to provide relief, and epidural blood patch (EBP) using 10 ml autologous blood was performed under light sedation. This was followed by resolution of the symptoms. Epidural injections of opioids and local anaesthetics are becoming increasingly popular for pain management in children. This implies that there may be an increasing number of unintentional dural punctures that may result in more PDPHs in children. Epidural blood patches are effective in treating PDPHs in adults but their use has been reported very rarely in children. Resolution of the patient's symptoms following EBP supported the diagnosis while illustrating that EBP can be useful in the treatment of PDPH in children.

This article has been cited by other articles:

				B. Robins and D. P. Boggs Caudal Epidural Blood Patch for Treating Intractable Vomiting in a Child After Placement of a Permanent Intrathecal Catheter Anesth. Analg., May 1, 2001; 92(5): 1169 - 1170. [Full Text] [PDF]